Clinical presentation and management of pelvic Morel–Lavallee injury in obese patients

Muneer, M.; El‐Menyar, Ayman; Abdelrahman, Husham; Murad, Musab Ahmed; Harami, Sara M Al; Mokhtar, Ahmed; Khawar, Mahwish; Awad, Ahmed; Asim, Mohammad; Latifi, Rifat; Al-Thani, Hassan

doi:10.4103/jets.jets_37_18

Cited by 8 publications

(15 citation statements)

References 32 publications

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“…There has been variably reported gender distribution, with theorised increased risk in females due to higher body fat percentage; however, this theoretical risk is likely outweighed by the higher incidence of trauma in younger males, to which the higher representation of this group can likely be attributed. 8,9,13 While MLLs can occur in response to various mechanisms of blunt trauma where a shearing force is exerted, 12,13 similar to other series, the predominant mechanism of injury in 66% of our cohort was motor vehicle or bicycle accidents. 14 Degloving injuries have previously been associated with severe concomitant injuries and high injury severity scores 13,15 ; Hakim et al 8 found that ISS was greater in the closed degloving injuries in comparison to open.…”

Section: Discussionsupporting

confidence: 72%

“…8,15 While MLLs were traditionally treated with open surgery, 23 a number of authors have described good outcomes with conservative measures including compression, percutaneous aspiration, or drainage. 3,9 Treatment should depend on the age/stage of the lesions, with conservative measures for smaller and acute lesions, while drainage +/À sclerotherapy or debridement and vacuum dressing for larger or persistent lesions. 10,24 There are potential benefits to actively treating acute lesions early, to prevent lesions increasing in and causing pain, skin necrosis, or poor cosmesis.…”

Section: Discussionmentioning

confidence: 99%

“…3,5 Treatment algorithms have been suggested by Nickerson et al, and also Greenhill et al, although have not been universally adopted. 4,9 In our cohort a majority had invasive management ranging from a single aspiration, to multiple washouts. Lesions that were managed with invasive treatment in our cohort were larger, with a median volume of 257 cc.…”

Section: Discussionmentioning

confidence: 99%

“…This included 20% which were closed degloving injuries. Muneer et al 9 described an incidence of 31.5% in obese patients with pelvic injuries who were admitted to a Level 1 trauma centre. As these lesions are often missed, authors suggest this may increase likelihood of complications.…”

Section: Introductionmentioning

confidence: 99%

“…This included 20% which were closed degloving injuries. Muneer et al 9 . described an incidence of 31.5% in obese patients with pelvic injuries who were admitted to a Level 1 trauma centre.…”

Section: Introductionmentioning

confidence: 99%

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Ten‐year incidence and treatment outcomes of closed degloving injuries (Morel‐Lavallee lesions) in a level 1 trauma centre

et al. 2022

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Introduction: Morel-Lavall ee lesions (MLL), also referred to as closed degloving injuries, result from traumatic shearing forces with separation of the subcutaneous fat from the underlying fascia. The aim of this study was to determine the incidence and treatment of MLLs at a level 1 trauma centre. Methods: Single-centre retrospective cross-sectional study of consecutive patients with an imaging diagnosis of a Morel-Lavallee lesion from 1/1/2010-31/12/2019. Demographic data, mechanism of injury, volume of lesion, management and outcome data were collated. Results: Sixty-six MLLs were identified in 63 patients (64% Male) with a median age of 49.5 years (19-94 years). Mechanism of injury were road traffic accidents in the majority (66%). Median injury severity score (ISS) was 17 (range 1-33). Patients on oral anti-coagulants had significantly larger lesions (181.9 cc v 445.5 cc, P = 0.044). The most common lesion location was the thigh (60.5%). Patients that underwent imaging within 72 h of injury had significantly larger lesions than those imaged more than 72 h after the inciting trauma (65 cc v 167 cc, P < 0.05). Management data were documented in 59% of lesions (39/66) in which 66.6% (n = 26) had invasive treatment. In the 31 patients where follow-up was available, 64.5% (n = 20) were persistent but decreasing in size. There was no significant difference in follow-up size for those who had invasive compared to conservative treatment (P = 0.3). Conclusion:The diagnosis of MLL should be considered for soft-tissue swelling in the context of shearing trauma. A variety of management options have been employed, with good overall outcomes.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ten‐year incidence and treatment outcomes of closed degloving injuries (Morel‐Lavallee lesions) in a level 1 trauma centre

et al. 2022

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Medico-legal considerations for Morel-Lavallée lesions

Scanvion

Garff

Gosset

et al. 2019

Forensic Sci Med Pathol

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The Morel-Lavallée lesion is an infrequent traumatic lesion that the forensic physician may need to evaluate during examination of a victim. Using a review of the literature and an illustrative case, the objective is to discuss the medico-legal issues (accountability, functional recovery and healing times, and aftermath) associated with Morel-Lavallée lesions. We describe the case of a 24-year-old motorcycle driver who was hit by a car. Clinically, the right lumbar region had a large 16×15 cm ecchymosis with subcutaneous fluid swelling found by palpation. A body scan revealed a Morel-Lavallée lesion among other lesions. On day 7, its thickness was decreased by half. Morel-Lavallée lesions are specifically induced by shearing force with moderate-to-high kinetics in an anatomical area with an underlying fascia. The associated functional disability is globally moderate, but a large lesion or recurrences can extend the time needed to recover. Apart from some exceptions, care without any delay in diagnosis and treatment allows evolution of the lesion without functional consequences, but these lesions are frequently unnoticed in the initial phase. Key points  The Morel-Lavallée lesion is an infrequent lesion, often missed in the initial phase, but should be known for medico-legal reports.  The Morel-Lavallée lesions are the result of a shearing force causing translational movement.  Road crashes are the main cause of Morel-Lavallée lesions and sports requiring sliding actions rank second in order of frequency.  Its functional disability is globally moderate, but a large lesion or recurrences can increase the time of resolution of the disability.

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A case report of severe unstable pelvic fracture with extensive perineal destruction and Morel-Lavallee lesion, with literature review

Zhou,

Wang,

Wang

et al. 2023

International Journal of Surgery Case Reports

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Clinical presentation and management of pelvic Morel–Lavallee injury in obese patients

Cited by 8 publications

References 32 publications

Ten‐year incidence and treatment outcomes of closed degloving injuries (Morel‐Lavallee lesions) in a level 1 trauma centre

Ten‐year incidence and treatment outcomes of closed degloving injuries (Morel‐Lavallee lesions) in a level 1 trauma centre

Medico-legal considerations for Morel-Lavallée lesions

A case report of severe unstable pelvic fracture with extensive perineal destruction and Morel-Lavallee lesion, with literature review

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